Beruflich Dokumente
Kultur Dokumente
CASE
CC: Oliguria
HPI
Px is known diabetic for yrs w/o maintenance
Not known hypertensive
W/o other co-morbidites
CASE
HPI
He has no known recent travel abroad or to local
provinces
No current exposure to domestic or wild animals
No hx of wading in flood or canal water but admits to
have indirect exposure to rodents which inhabit nearby
places
CASE
7 days PTA
Undocumented fever with associated body malaise,
No cough, chest pain, headache, abdominal pain,
jaundice, diarrhea, melena, hemaochezia,
nausea/vomiting and hematemesis
Patient just take Paracetamol and/or Ibuprofen every 6-8
hrs with temporary lysis of fever but only to recur
several hrs after
Px still did not seek consult and continued his work
CASE
In the interim
Undocumented fever was intermittent,
Still no consult
Still take same meds
On succeeding days
Onset of calf pains
No intermittent claudications, cyanosis, dypsnea,
crackles, dysuria, oliguria
CASE
At the day of admission
Still with undocumented fever, myalgia, calf pain
Noted decrease in urine output which was ~less than a
cup
CASE
Past Medical Hx
+ PTB treatment completed (2013, DOTS)
(-) bronchial asthma
(-) allergies to food/meds
(-) known malignancy
(-) previous surgery
CASE
Family Hx
(-) DM, HPN, CAD/CVD
(-) malignancy
(-) hepatitis/PTB
(-) autoimmiune/rheumatologic diseases
(-) other heterofamilial disease
CASE
Personal/Social Hx
Nonsmoker
Alcoholic beverage drinker (~50g/occasion once a week
for 5 years)
Denies illicit drug use
Has one female, heterosexual partner, Filipino, with no
promiscuous sexual history
CASE
ROS
(-) recurrent headache
(-) coughs/colds
(-) dyspnea
(-) orthopnea
(-) polyuria
(-) weight loss
Heart
Adynamic precordium
PMI at 5th ICS LMCL,
Tachycardic, regular rhythm, no murmurs
CASE
Abdomen
Flat, soft, nontender and normoactive bowel sounds
No masses, no organomegaly
No CVA tenderness, no bladder distention
DRE
No external haemorrhoids, no anal fissures, good sphincter tone
Intact rectal vault, no masses, no fecal material on examining finger
Extremities
Full equal pulses, no edema and no cyanosis
CASE
Neuro Cranial Nerves
CN I Smells coffee
CN II Both pupils are reactive to light (3mm 2 mm)
CN III, IV, VI Intact and full EOM
CN V V1-V3 intact
CN VII No facial asymmetry
CN VIII Intact gross hearing
CN IX, X Good gag reflex
CN XI Equal shoulder shrug
CN XII Tongue in the midline upon protrusion
CASE
Neuro Motor
5/5 5/5
5/5 5/5
Neuro Sensory
100 100
100 100
CASE
Neuro - Reflexes
Bacteria Few
SALIENT FEATURES
PERTINENT POSITIVES PERTINENT NEGATIVES
HISTORY OF PRESENT ILLNESS HISTORY OF PRESENT PAST MEDICAL HISTORY
Diabetic for 5 yrs with no maintenance ILLNESS No allergies to food
meds Not hypertensive and meds
Indirect exposure to rodents No other co-morbidities
No known malignancy
Undocumented fever with body malaise No history of travel
Onset of calf pain No current exposure to No previous surgery
Myalgia domestic or wild
Decrease in urine output animals PHYSICAL EXAMINATION
No history of wading in No jaundice
PAST MEDICAL HISTORY flood or canal water No rash
PTB Tx completed (2013, DOTS) Anicteric sclerae
REVIEW OF SYSTEMS No conjunctival
REVIEW OF SYSTEMS No recurrent headache suffusion
(+) Blurring of vision No cough and colds
No cervical
No dyspnea nor
orthopnea lymphadenopathy
No dysuria nor polyuria No cardiopulmonary
No joint pains changes
No abdominal pain No abdominal changes
No bowel changes No peripheral changes
No weight loss No nuchal rigidity
APPROACH TO
DIAGNOSIS
(-) cough/colds
APPROACH TO DX (-) abdominal
changes
Leptospiro
sis
Fever, Body malaise, Bacterial
Typhoid
fever
Non Flu
Myalgia
infectious
Viral Dengue
Infectious
Chikungun
ya
Parasitic Malaria
Fungal
DIFFERENTIAL
DIAGNOSES
DENGUE
RULE IN RULE OUT
Fever (-) skin rash
Body Malaise (+) calf pains
Oliguria (-) headache
Myalgia (-) nausea and vomiting
(-) abdominal pain
Decreased platelet concentration (-) hematochezia
(-) hematemesis
(+) Leucocytosis
Normal Hct
RULE OUT
World Health Organization, Special Programme for Research, Training in Tropical Diseases, World Health Organization. Department of Control of Neglected
Tropical Diseases, World Health Organization. Epidemic, & Pandemic Alert. (2009).Dengue: guidelines for diagnosis, treatment, prevention and control.
World Health Organization.
MALARIA
RULE IN RULE OUT
Fever (-) Chills
Oliguria (-) Sweating
Body malaise (+) Calf pains
Myalgia (-) abdominal pain
(-) history of travel
(-) anemia
Normal Hct
RULE OUT
World Health Organization. (2015).Guidelines for the treatment of malaria. World Health Organization.
CHIKUNGUNYA
RULE IN RULE OUT
Fever (+) Oliguria
Myalgia (+) High Crea
Calf Pain
Leukocytosis
Low Platelet Count
RULE OUT
016). Chikungunya virus Symptoms. Retrieved from https://www.cdc.gov/chikungunya/symptoms/index.html. Retrieved on Sept.6, 2017
LEPTOSPIROSIS
RULE IN RULE OUT
Indirect exposure to rodents (-) Jaundice
Fever (-) Anemia
Myalgia
Calf Pain
Oliguria
Leucocytosis
Low platelet count
High Creatinine
Blurring of Vision*
CANNOT BE RULED OUT
CONFIRMATORY DX
Capillary Vasculitis
PATHOPHYSIOLOGY
Capillary Vasculitis